Celiac disease (CD) and type 1 diabetes (T1D) are T-cell mediated autoimmune diseases that have several overlapping features. Both diseases typically originate in childhood, with asymptomatic preclinical stages and autoantibody development before disease onset. The etiology of CD and T1D include a combination of genetic and environmental factors; most notably, shared HLA antigen loci are important risk factors for both diseases.1

In the past 3 decades, there has been a global rise in the incidence of T1D and CD.2–4 CD occurs in ∼5% to 8% of individuals with T1D,5 raising the question of whether 1 disease predisposes to the development of the other, or if simply common genetic and environmental risk factors drive disease co-occurrence without a causal link. A better understanding of the pathophysiology leading to autoimmunity and disease onset in CD and T1D may result in more effective treatment strategies for both conditions, and may suggest novel targets for intervention before disease onset.

Previous studies to determine a causal association between T1D and CD are limited …

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